Glandular resection and central embedding in hypospadias repair--a novel modification of the Barcat technique

An insight of pathological anatomy of urethral stricture and surgical manipulations for children suffered from hypospadias

BACKGROUND

Manipulation of urethral stricture is difficult and challenging. Accurate analysis and evaluation of the pathological circumstances of narrowed urethra and surrounding tissues were important for cure. The detailed descriptions of anatomic pathology of urethral stricture are rare. An insight of the pathological anatomy of the strictured urethra and the corresponding corrections is essential for an ultimate cure. The aim of the study is to interpret the pathological anatomies of the strictured urethra and the corresponding surgical manipulations.

METHODS

From April 2007 to April 2020, eight boys who suffered from postoperative urethral stricture for hypospadias correction were studied retrospectively. The pathological anatomies of the strictured urethra were described and the corresponding surgical manipulations were analyzed.

RESULTS

All eight patients were eventually cured through surgery. The patient age was 2.58-11 years old (mean value of 4.73). The therapeutic duration was 12-130 months (mean value of 47.75). The surgical manipulation was 1-9 times (mean value of 4.5). Curative follow-up was 8-138 months (mean value of 77.75). They were all applied with flap tubularization for their primary urethroplasty.

CONCLUSIONS

Based on the principal contradiction of the pathological anatomies of the urethral stricture, one-stage or staged surgical manipulations can be applied. After stricture was resolved, refining techniques of Mathieu, TIP, modified Duckett, glanular reconstruction and et al. can be used. Although it was tiring, utilizing the ventral or dorsal penile flap with relatively good blood supply and flexibility to reconstruct the urethra is possible and successful. To reconstruct an anatomically normal urethral tract should be pursued in the primary and consequential procedures for hypospadias and urethral stricture.

Tubularized Reconstructed Plate Urethroplasty: An Alternative Technique for Distal Hypospadias Repair

OBJECTIVE

To report current results of a new surgical technique, tubularized reconstructed plate urethroplasty (TRPU) in distal hypospadias repair which allows the tubularization of urethral plate without incision or grafting.

METHODS

This study is a prospective single surgeon series. Between January 2019 and March 2020, total of 158 patients underwent hypospadias repair, and 29 selected patients had TRPU procedure. Demographic data, duration of follow-up, complications were recorded. A vertical incision is made starting from halfway up the glans. This incision creates a diamond like defect which enables wedge removal of a segment of spongiosum tissue from the base of urethral plate extending to the hypospadiac meatus. Vertical incision is closed horizontally. The urethral plate is stretched and loosened from the base and re-secured into its bed using quilting stitches. Reconstructed urethral plate ensures the required width to allow the formation of neourethra of adequate circumference, followed by a formal glansplasty.

RESULTS

Preoperative glans width was 13.4 ± 0.9 mm, urethral plate width was 6.1 ± 0.9 mm. Mean postoperative follow-up period was 13.6 months. All patients had successful functional outcome and cosmetically satisfying appearance. None of the patients required meatal calibration. The total complication rate was 3.4%.

CONCLUSION

Native urethral plate itself is used as a natural flap to increase the surface area of the urethral plate in this new perspective of urethroplasty method. We believe that TRPU procedure provides an alternative approach for the formation of neourethra and it is a successful and relatively simple procedure with low complication rates, good cosmetic results and promising successful functional short-term outcome.

The glandular resection and central embedding modification (GRACE) in Duckett and Barcat hypospadias repair

INTRODUCTION

We recently reported a novel modification of the Barcat technique termed glandular resection and central embedding (GRACE). Here, we report results from a large patient population and apply this modification also to Duckett hypospadias repair.

PATIENTS AND METHODS

We retrospectively evaluated 488 patients who had undergone primary or secondary hypospadias repair by Barcat or Duckett using the GRACE modification.

RESULTS

For all GRACE repairs, cosmetic appearance was favorable regarding meatal position, shape and overall appearance. Maximum and average flow were above the 5th percentile in at least 95%. In Barcat and Duckett repairs, urethrocutaneous fistulas occurred in 5 and 30.7%, urethral strictures in 3 and 20.8%, and meatal strictures in 5 and 25.3%, respectively.

CONCLUSIONS

The initially reported favorable cosmetic and functional results were confirmed both for Duckett and Barcat repair using the GRACE modification. Complication rates were favorably low for Barcat and higher, but consistent with published results, for Duckett repair.